远端胃癌根治术后三种常见消化道重建方式的临床对比分析

发布时间：2018-07-27 15:40

【摘要】：背景:有数据表明,我国胃癌病人的发病率高居全世界第二位。每年约679100人新诊断为胃癌,498000人死于胃癌。其中,远端胃癌约占50%。迄今为止临床上能够治愈胃癌的唯一手段只有以外科手术为主导的综合诊疗。胃癌根治术后进行消化道重建的方法经多年发展改良后多种多样,其中在我国远端胃癌根治术后最常用的吻合法主要有三种,分别为Billroth Ⅰ式、Billroth Ⅱ式以及Roux-en-Y吻合,三种吻合术式各有利弊,目前还没有临床上公认的最佳选择。本文就三种胃癌术后消化道重建方式进行临床数据资料的对比分析,以期能够为远端胃癌根治术后消化道重建方式的合理选择提供临床依据。目的:通过对收集的相关数据进行临床对比分析,对远端胃癌根治术后三种常见消化道重建方式的合理性作再探讨。方法:通过回顾性选取从2014年9月到2016年3月期间于吉林大学中日联医院胃肠外科行远端胃癌根治术后消化道重建的病人。入组病人既往无腹部手术史,术前有本院明确的胃镜病理报告证实为胃癌,病灶位于胃下部或部分胃小弯侧。结合术前CT、超声等辅助检查无远处转移,术前调整身体状态可耐受手术,限期拟行远端胃癌根治术,术后病理与术前病理一致。入组病人共87例,其中Billroth Ⅰ式22例、Billroth Ⅱ式32例,Roux-en-Y吻合33例。对病人一般资料及围术期指标如手术时间(min)、术中出血量(ml)、胃肠功能恢复时间(d)、术后住院时间(d)、术后消化道功能恢复情况,病人术后6月特殊症状量表随访调查、术后1年内并发症情况等指标进行统计学分析。结果:1.三组病人在年龄、性别、病理类别及TNM分期等一般临床数据上未发现明显差异((P0.05),没有统计学意义,具有可比性。2.三组病人手术时间和术中出血量与手术操作的复杂程度表现为正相关,Billroth Ⅰ吻合术手术最为简单,手术时长及术中的出血量最少,而Roux-en-Y吻合术操作最为复杂,手术时长及术中出血量最多,Roux-en-Y吻合组拔管时间、经口进食时间、住院天数均较Billroth Ⅰ吻合术延长(P0.05);Roux-en-Y吻合组拔管时间和经口进食时间与Billroth Ⅱ组相比较也更长,差异表现出统计学意义(P0.05).3.三组病人术后6月Chew-wun Wu特殊症状量表评分数据显示:Roux-en-Y吻合组与Billroth Ⅰ吻合及Billroth Ⅱ吻合组分别比较,其中反流烧心感项的评分(Billroth Ⅰ吻合:1.69±0.31;Billroth Ⅱ吻合:1.58±0.49;Roux-en-Y吻合:2.15±0.63),低于另外两组,P0.05,有统计学意义。其他症状评分未见明显差异。4.三组病人术后1年内并发症Roux-en-Y组与Billroth-I组并发症差异经卡方检验在胆汁反流、倾倒综合征、残胃炎、反流性食管炎方面P0.05,发生率更低,有统计学意义,其他并发症差异无统计学意义(P0.05),而Billroth Ⅱ组各种并发症的发生情况除内疝和输入襻梗阻外较Roux-en-Y组或Billroth-I组高(P均0.05)。结论:远端胃癌根治术后常用的三种消化道重建方式各有长短利弊,基于迄今的临床证据,Billroth Ⅰ式操作简单,有条件时应为首选;Billroth Ⅱ式操作比Roux-en-Y式简捷,但并发症多;Roux-en-Y手术操作复杂,胃肠功能恢复慢。但重建抗反流作用显著优于Billroth Ⅰ式及Billroth Ⅱ式重建,远期病人生活质量良好,值得推广使用。
[Abstract]:Background: data show that the incidence of gastric cancer patients in China is the second highest in the world. About 679100 people are newly diagnosed with gastric cancer and 498000 people die of gastric cancer each year. Among them, distal gastric cancer accounts for about 50%. so far the only means to cure gastric cancer is only comprehensive surgery guided by surgery. After radical gastrectomy, the digestive tract is carried out. The method of reconstruction has been varied after years of improvement. Among them, there are three main methods of kissing most commonly used after radical resection of distal gastric cancer in China, which are Billroth I, Billroth II and Roux-en-Y. The three kinds of anastomosis have both advantages and disadvantages. At present, there are no clinically recognized best choices. This article is about the postoperative elimination of three kinds of gastric cancer. In order to provide clinical basis for the rational selection of digestive tract reconstruction after radical resection of distal gastric cancer, the clinical data of three kinds of common digestive tract reconstruction after radical resection of distal gastric cancer were analyzed. Methods: from September 2014 to March 2016, the patients with digestive tract reconstruction after radical gastrectomy of gastric cancer in the gastrointestinal surgery department of China Yuru Hospital of Jilin University from September 2014 to March 2016 were selected. The patients had no history of abdominal surgery. The preoperative CT, ultrasound and other auxiliary examinations had no distant metastasis. The preoperative adjustment of the body state could be tolerated and the distal radical gastrectomy was performed. The postoperative pathology was consistent with the preoperative pathology. There were 87 cases in the group of patients, including 22 cases of Billroth I, 32 cases of Billroth II, and 33 cases of Roux-en-Y anastomosis. Between (min), intraoperative bleeding (ML), recovery time of gastrointestinal function (d), postoperative hospital stay (d), postoperative recovery of digestive tract function, follow-up investigation of special symptom scale in June after operation and 1 year postoperative complications. Results: 1. and three groups of patients were in age, sex, pathological category and TNM staging. No significant difference (P0.05) was found (P0.05). There was no statistical significance. There was a positive correlation between the operation time and the amount of intraoperative bleeding and the complexity of the operation. The Billroth I anastomosis was the most simple, the operation was the least, and the Roux-en-Y anastomosis was the most complicated, and the operation was long. And the amount of bleeding in the operation was the most. The time of extubation in the Roux-en-Y anastomosis group was longer than that of the Billroth I anastomosis (P0.05), and the time of extubation and the feeding time of the Roux-en-Y anastomosis group were also longer than those of the Billroth II group. The difference showed that the patients in the group of.3. three were statistically significant in the June Chew-wun Wu disorder after the operation. The scale score data showed that Roux-en-Y anastomosis group and Billroth I anastomosis and Billroth II anastomosis group were compared respectively, in which the score of reflux heart burning (Billroth I anastomosis: 1.69 + 0.31; Billroth II anastomosis: 1.58 + 0.49; Roux-en-Y anastomosis: 2.15 + 0.63), lower than the other two groups, P0.05, with statistical significance. Other symptoms score was not clear. The difference of complications between group Roux-en-Y and group Billroth-I in group.4. three after 1 years, the difference of complications between group Roux-en-Y and group Billroth-I by chi square test in bile reflux, dump syndrome, remnant gastritis and reflux esophagitis was lower and statistically significant. There was no statistical significance in other complications (P0.05), and the incidence of various complications in group Billroth II. The results were higher than that of group Roux-en-Y or group Billroth-I (P 0.05). Conclusion: the three kinds of digestive tract reconstruction after radical resection of distal gastric cancer have advantages and disadvantages. Based on the clinical evidence to date, the operation of Billroth I is simple and the condition should be the first choice; Billroth II operation is simpler than Roux-en-Y type. There are many complications. The operation of Roux-en-Y is complicated and the function of gastrointestinal recovery is slow. However, the reconstructive anti reflux effect is better than that of Billroth I and Billroth II reconstruction. The quality of life of the long term patients is good, and it is worth popularizing.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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